Program for Evaluating Payment
Patterns Electronic Report

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Training & Resources for Partial Hospitalization Programs (PHP)

PEPPER Resources

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Current PEPPER User's Guide:

Jurisdictions:

  • View a list of the 12 MAC jurisdictions and the number of providers in each jurisdiction in total and by state for PEPPER Q4FY13 (38 KB XLS).
  • View a list of the 15 MAC/FI jurisdictions and the number of PHPs in each jurisdiction in total and by state for Q4FY12 (36 KB XLS).
  • View a list of the 16 MAC/FI jurisdictions and the number of PHPs in each jurisdiction in total and by state for PEPPER version CY2011.

Partial Hospitalization Programs PEPPER Training Update - March 2013

PEPPER Training (September 11, 2012):

  • Partial Hospitalization Program PEPPER Training: Session 1 – This session reviews the new PEPPER for Partial Hospitalization Programs (PHPs). It includes the history and background of PEPPER, and a description of the areas at risk for improper Medicare payments. It also discusses percents and percentiles and the comparison groups.(Duration: 31:44, requires Flash 10.0 or later)
  • Partial Hospitalization Program PEPPER Training: Session 2 − This session is a demonstration of a PHP PEPPER to review the reports included, and a discussion about how the PEPPER can be used. (Duration: 37:00, requires Flash 10.0 or later)
  • Access alternate file formats and a transcript of this training.
  • Download the PowerPoint slides (653 kbs, PDF) for the PHP PEPPER training session.
  • View questions and answers (102 kbs, Word) from the September 11, 2012 PHP PEPPER training session.
  • PHP question and answer session audio: This question and answer session, held on October 2, 2012, addresses provider questions about PEPPER for PHPs. (Duration: 52:12, mp3, requires multimedia player).
  • Access a transcript (72kbs, Word) of the October 2, 2012 PHP PEPPER question and answer session.
    Note: During the October 2, 2012 Partial Hospitalization Program PEPPER Question and Answer session, one of the participants asked if individual psychotherapy sessions of less than 45 minutes were identified in the PEPPER as one unit of individual psychotherapy. The "No Individual Psychotherapy" target area identifies the proportion of episodes of care that did not have any individual psychotherapy (revenue code 0914) or psychiatric testing (revenue codes 0900 or 0918). We did see instances of CPT code 90816 (individual psychotherapy, duration approximately 20-30 minutes) and revenue code 0914 in the PHP claims data, and these instances would have been identified as a unit of individual psychotherapy in the PEPPER.

    If PHPs have questions about submitting the technical portion of individual psychotherapy on their PHP claims, they should contact their Medicare Administrative Contractor (MAC) for questions related to billing or claims submission.

Demonstration PEPPER:

  • Demonstration PEPPER version Q4FY13 (443 KB XLS, updated 3/19/2014)

What is PEPPER?

The PHP PEPPER is a report that summarizes a PHP’s Medicare claims data in areas that may be at risk for abuse or improper payment. PEPPER compares a PHP’s claims data statistics with aggregate statistics for other PHPs in the state, MAC/FI jurisdiction and the nation. PHPs with high billing patterns (at or above the national 80th percentile) are identified as at risk for improper Medicare payments and are encouraged to ensure that they are complying with Medicare payment policy, that services provided to beneficiaries are medically necessary and that medical record documentation supports the services that are billed. PHPs administered through Community Mental Health Centers, free-standing inpatient psychiatric facilities (IPF), short-term acute care hospitals and IPF distinct part units of short-term acute care hospitals are included in PEPPER.

PEPPER cannot identify the presence of improper payments. Only a review of the medical record can determine whether services are medically necessary and appropriately billed.

Distribution Schedule

TMF will distribute PEPPER according to this schedule and methods.

Other Resources:

Sample PEPPER
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Curious as to how the PHP PEPPER looks? View a PHP demonstration Q4FY13 PEPPER (1 MB XLS).

Q&A Session on the PHP PEPPER

Downlaod handout.